Reproductive Health Care Requires Reproductive Justice

By Ashley Houston, Center for Healthcare Organization and Implementation Research

August 8, 2017

Research

Public health researcher Nancy Krieger acknowledged in a 1990 commencement address to UC Berkeley’s School of Public health that public health is inherently part of public welfare with roots in social justice. As we address health disparities, we address social inequalities. Access to reproductive care, namely abortion and contraceptives, is a hot political topic. In fact, hundreds of thousands came out to march on January 21, 2017 in the United States and around the world for the Women’s March. On March 8, 2017, women organized a “day without women” inspired by a “day without immigrants.”

Black feminists have pointed out that advocating for reproductive justice does not stop at abortion rights, contraceptive access, or even the labor and delivery process. It also includes dismantling health and social inequalities throughout the life cycle.

In my own research as a medical anthropologist, I have heard immigrant women of color voice frustrations regarding their reproductive care. For example, circumcised Somali women, with whom I do community-engaged research, report significant obstacles to culturally appropriate reproductive and preventative gynecological health services in the U.S. The lack of appropriate reproductive health care for Somali women largely reflects American doctors’ unfamiliarity and inexperience with female circumcision, and hints at ethnocentric biases within western reproductive medicine. To compound these barriers further, Somali women face discrimination due to skin color, religious identification, and perceived immigration status—beyond healthcare, and within it.

Somali women represent one group, of many, who experience discrimination and injustice in healthcare settings in the United Sttes. Boundaries of care for marginalized women illuminate the necessity for reproductive justice within public health discourse as we address reproductive care that goes beyond access to abortion and contraception. That is not to say that women do not need access to safe abortion or contraception—we certainly do, particularly for those who are disproportionally affected by policy restrictions for abortion. However, Somali women’s experiences reflect larger concerns over the divide between reproductive health care and reproductive justice.

Black feminists have pointed out that advocating for reproductive justice does not stop at abortion rights, contraceptive access, or even the labor and delivery process. It also includes dismantling health and social inequalities throughout the life cycle. Yet, we often explore the links between discrimination and health, at the individual or population level, comfortably removed from social justice, feminist, or reproductive justice frameworks.

It is essential to reflect on how mainstream feminism silences marginalized women, including immigrants, Muslim women, and other less-visible, non-dominant groups at greater risk for ethnocentric messaging in public health campaigns. As public health workers, when we focus on reproductive health care, we address larger social inequalities. Therefore, to reduce reproductive health disparities we must move toward supporting equality throughout the entire reproductive life cycle by critiquing structural and social systems that perpetuate conditions in which these disparities thrive, including within the mainstream feminist movement.

The author wishes to acknowledge the contributions to this article by Bayla Ostrach, PhD formerly of Boston University School of Medicine, Medical Anthropology and Cross Cultural Practice.

Ashley Houston is a recent graduate of BU School of Medicine where she earned her MS in Medical Anthropology and Cross Cultural Practice (’16). She currently works as a health science specialist at the Center for Healthcare Organization and Implementation Research (CHOIR). Ashley is a community activist and is involved with the Greater Boston Muslim Health Initiative.